Trichotillomania,
also known as TTM or Trich, is an impulse control disorder that causes a person
to be compelled to pull out their own hair. It is literally read as hair
(trich-) pull (till-) obsession (mania). It is also closely related to OCD and
manifests like you would expect an addiction to. It has unique effects on every
individual, but there are a few things you would expect to see in most
trichotillomaniacs.
One factor that
can vary among people is the pull site. Some people pull from only their
eyelashes and eyebrows, and some only from the crown of the head. Many people
pull from pretty much everywhere, and there are even those that pull from rare
sites like the armpits. It is also common for trichotillomaniacs to follow a
specific ritual after pulling a hair, like rubbing the root on their lips or
running the hair through their fingers before dropping it. In severe cases,
trichotillophagia may also be present, compelling the person to ingest the
hair. Excessive consumption of hair can be dangerous and even deadly if it
results in a trichobezoar (hair ball) that can block the digestive tract.
Because it is not
often discussed, trichotillomania and the people who suffer from it are often
misunderstood. It can be mistaken for a bad habit or a method of self-harm, but
it is neither. The truth is that hair pulling is normally not painful for
people with this condition. Pulling can be done consciously or subconsciously,
but there is usually a sensation that brings attention to the pull site, like
an itch or a tingle that demands action, and which is commonly accompanied by
mounting anxiety about a particular hair. Once the hair has been pulled, there
is an immediate rush of satisfaction, like the follicle has been cleansed and
the problem eliminated. Unfortunately, this satisfaction is short-lived and
quickly replaced by guilt and shame. Whether or not shame is a symptom of TTM
or just a result of the visible changes it causes, it is probably one of the
most unbearable things about the condition.
Unfortunately,
just knowing the mechanics of trich does not always help people understand the
effects of it on a human being. Comparatively, my case is not so severe. I have
seen people whose lives are completely ruled by it, and I cannot image how they
manage because I am in a constant struggle. As is common for TTM, I started
showing symptoms when I was young, probably around eight years old.
I can't remember
the precise moment when it started, but I remember some of the thoughts I was
beginning to have around that time. I remember the fascination I had with the
superstition of blowing on fallen eyelashes to get a wish granted. I thought
that if eyelashes fell on their own, then some of them must be loose, so I
started tugging on them lightly to see if I had any loose ones to wish on. I
also remember the itch. Of course it was probably an early symptom, but I
didn't know anything about that. I just figured that an itch probably meant
that a hair was about to fall out, so I should start tugging there just to make
sure. I even remember why I started putting
the roots to my lips. I'd read in a book that the lips are one of the most
sensitive parts of the body, and when I put my fingers to my lips after pulling
I could feel whether or not I had managed to get hold of a hair. Then it would
be in the perfect place to blow on it. It's possible that these thoughts
and memories are completely fake justifications that my mind made up and
started believing long ago, but they feel as real as anything else. The escalation
must have been gradual, because everything from around that time is such a
blur. There are some specific events that stick out, where I got all defensive
and jumpy just at the mention of eyelashes, but it hadn't occurred to me yet
that it was a habit, addiction, or anything else. It was just a secret. I
didn't have a good reason why it should be a secret, but I guess I felt
embarrassed about it even then.
There is one thing
that I remember with perfect clarity, and I'm sure that these memories are real.
I was on vacation with my family in the Virgin Islands. It was one of our most
eventful (and awful) vacations ever. I believe I was in fifth grade by then. I
can see everything that happened in my mind in perfect detail. I remember
eating the fruit that the motel was named after (which I didn't like at all),
and the scrambled eggs for breakfast that I tried to avoid every day. I
remember being traumatized by a snail coming out of a shell that I thought was
empty, and the ants that got into my mom's drink. I remember driving around the
town and visiting a dingy deli, and then going to a restaurant where my dad
gave a waitress inspiration to invent a new drink. I think I even remember
seeing the green flash, although it's possible that I just imagined it so many
times that I feel like I saw it, because I'm pretty sure I had my head under
the table when my parents got all excited about seeing it. What I remember best
is getting sick. My parents were scuba diving and they wanted me to come see
the moray eel they found, but I didn't want to because the water was cold. They actually got fairly mad at me. They went on and on about how the water was 85
degrees, and how this was a once in a lifetime opportunity that I was wasting,
and how much money they had spent on the trip. They felt pretty sorry
though, once they realized that I thought the water was cold because I had a
103.6 degree fever. Not long after my little sister got sick too. We
tried to go to the hospital but all the locals warned us not to. After I was
prescribed some pretty dangerous drugs, my parents realized why. We ended up having
to stay an extra week because we were too sick to fly, but it wasn't fun like
extra-long vacations should be. Maybe it was the stress, or the fact that the
mattress was super uncomfortable (turns out it was upside-down and we were just
lying on the box springs with a sheet over it), but my pulling reached a
turning point then. I was lying awake at night, pulling on my eyelashes and
putting my fingers to my lips because I couldn't see if I had pulled a hair in
the dark. There was one thick hair that I was sure I'd managed to get, but when
I put it to my lips the root was cold and wet and gooey, which really freaked
me out. That obviously wasn't a loose hair; the root was still alive. I dropped
it quickly and put my hand back to my face to survey the damage. I must have
been pulling more than I thought, because there was a gap in my eyelashes. The
skin was completely smooth under my finger where part of my eyelash should have
been. I was so anxious that I ran to the mirror the first thing next morning. I
panicked when I saw the gap, but it was kind of to the outside, not over my
pupil, so I figured no one would see it if I was careful. However, I obviously
didn't spend enough of my time looking down, because my mother saw it the very
next day. She grabbed my chin and turned my head and demanded an explanation
from me. I was completely mortified. It was definitely one of the top five most
embarrassing things to ever happen to me. I was so ashamed that I done that to
myself that I started making up ridiculous lies. I mean, truly unbelievable.
I'm pretty sure I wound up blaming it on my fourth grade teacher, which
obviously no adult would believe but I didn't really have much to work with.
Anyway, that was the first time that my hair loss was visible, which is one of
the main qualifications for a diagnosis.
Over the years, I
was mostly able to forget about pulling out my hair. Every now and then I'd
realize that my eyebrows were getting to thin, or that I had a bunch of short
hairs stick out of the top of my head that looked conspicuous, but mostly
I just figured it was a weird habit. I blamed by eyebrow problems on plucking,
which some girl in elementary school had insisted that I start doing or else
people would make fun of me for my unibrow. Yes, people, by all means pressure
young girls to start removing their body hair as soon as possible. They might
not have enough self-image problems yet. If you're lucky, they'll develop a
devastating disorder. But all sarcasm aside, I really have a problem with
people who police others on their image. As someone who's struggled with
showing my face in public for something I can't control, I have to say that I
would be glad to have my unibrow back, and I would laugh at anyone who tried to
tell me I should clean it up. Okay, maybe I wouldn't, but I'd like to imagine
that I'm not so compliant to social constructs. Overall, though, I have to say
that the fear of how others saw me definitely drove my obsession with my hair.
I remember going home from gym in middle school, embarrassed that all the other
girls had shaved their legs and I hadn't. I was so desperate to fit in that I
made my mom show me where the razors were, though she thought I was too young
to be worrying about shaving. And if I ever thought that the short hairs on the
top of my head were too visible, I would wear the scarf I made my mom for
Mother's Day on my head to hide it. She thought I was wearing it because it
reminded me of her, which made me feel even guiltier. Aside from the occasional
gap in my eyelashes, middle and high school were pretty normal. Then I went to college. *insert dramatic music here*
You'd think that
I'd remember something really important and life-changing, like learning that
trichotillomania was actually a real and fairly common condition, but I don't
remember it at all. All I know is that by the time I was in college, I knew
what I had and I wasn't really all that concerned about it. But college is stressful
and by the start of my second semester, I had a pretty sizable hole in one of
my eyebrows. I'd never had a gap there before, but I figured that I could just
cover it up with some eyebrow pencil for a few weeks and it would grow back in.
Sadly, I haven't gone a day since then without drawing my eyebrows in. The hole
just got bigger and bigger. Then there was one on the other side. Then they
were both barely there. Instead of just filling my eyebrows in, I was drawing
them on completely. And can I just say that it might seem easy, but you don't
realize until you have to create eyebrows out of nothing that you have
absolutely no idea what shape an eyebrow is supposed to be. I've gotten pretty
good at it. My Art Major friends are impressed.
Eventually, I
realized that the worst part of not having eyebrows was not the fact that my
face looked a bit alien (because people seriously look weird without eyebrows)
but that the embarrassment was causing so much stress. I started telling people
that I had trichotillomania, and the reactions I've received have restored my
faith in humanity. I don't have a problem with letting my friends see me
without my eyebrows penciled on, which is a huge weight off my shoulders. I
often discuss it in public, and if people ask me what I'm talking about, I let
them look at my eyebrows really closely and they almost always tell me that I'd
done such a good job that they couldn't tell they weren't real. I still feel
nervous around strangers when I'm not in make up, and can't just go outside
without making sure that they look perfectly full and symmetrical, but as soon
as I let go of the stress of keeping such a huge secret, I started on the road
to recovery. My eyebrows and eyelashes both are looking a bit worse for the
wear, but they all exist at least, even if they don't quite look right.
If I'm ever doing
really badly, I wear a head scarf and lab goggles so that I simply can't reach
the hair to pull it. Lab goggles look stupid, so I don't wear them in public,
but they're great for when I'm reading or working at home. I've been told the
head scarf makes me look like I have cancer, but I figure my three-foot braid
makes it pretty clear that I have plenty of hair on my head. (Am I
compensating? Maybe.)
As I said before,
the fact that I even have hair on my head and eyebrows and eyelashes is a
luxury that many trichotillomaniacs don't have. My case is mild. I don't have
huge bald spots. I haven't had to shave my head (I think I would die without my
braid) or get a wig. I don't get infections in my follicles. I don't eat my
hair. And if I manage to keep my hands away long enough, my hair always grows
back. Not everyone is so lucky. But if people with worse trich problems can
overcome it, then I certainly can. : )
I hope I have
given you (if anyone managed to finish this small book I wrote) some food for
thought. Next time I'll try to write something a little shorter and funnier.
